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Determinants of dyspnea in chronic heart failure
Kupper,N. Bonhof,C.S. Westerhuis,Bert Widdershoven,J.W.M.G. Denollet,J.
Kupper,N.
Bonhof,C.S.
Westerhuis,Bert
Widdershoven,J.W.M.G.
Denollet,J.
Abstract
Background Dyspnea is a hallmark symptom of heart failure (HF), associated with impaired functional capacity and quality of life. The experience of dyspnea is multifactorial and may originate from different sources. This study set out to examine the relative importance of potential contributors to dyspnea, ie, disease severity, inflammation and psychologic distress in a large prospective cohort of chronic HF patients. This study further aimed to examine the differential influence of cognitive and somatic symptoms of psychologic distress. Methods and Results Dyspnea complaints (Health Complaints Scale), demographic and clinical variables, and psychologic factors (ie, depression, anxiety, and Type D personality) were assessed in 464 HF patients (mean age 66.0 y, 70% men) at baseline and 1-year follow-up. Inflammatory markers (ie, tumor necrosis factor [TNF] α, interleukin [IL] 6, IL-10, soluble TNF receptors 1 and 2) were also assessed at both time points in a subsample (n = 247). Linear mixed modeling analysis with maximum likelihood estimation showed that when determinant clusters were entered separately, comorbid chronic obstructive pulmonary disease (COPD) was significantly associated with dyspnea complaints (P = .039), as were depression (P < .001) and anxiety (P < .001), whereas inflammation did not significantly affect dyspnea complaints. When all determinant clusters and covariates were entered together, results showed that body mass index (P = .013), COPD (P = .034), age (P = .005), depression (P < .001), and anxiety (P < .001) were significant independent associates of dyspnea complaints. Somatic depressive and somatic anxiety symptoms were responsible for these latter associations. Conclusions The experience and report of dyspnea in HF is determined foremost by somatic symptoms of psychologic distress, being of older age, being overweight, and having comorbid COPD, with disease severity and systemic inflammation levels playing an ancillary role. These findings suggest that psychologic distress should be considered when treating dyspnea complaints in patients with HF. Key Words: Dyspnea ,heart failure, depression, anxiety, Type D, inflammation
Description
Copyright © 2015 Elsevier Inc. All rights reserved.
Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
Research Projects
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Journal Issue
Keywords
Dyspnea, Heart Failure, Depression, Anxiety, Type D, Personality, Inflammation, SDG 3 - Good Health and Well-being
Citation
Kupper, N, Bonhof, C S, Westerhuis, B, Widdershoven, J W M G & Denollet, J 2016, 'Determinants of dyspnea in chronic heart failure', Journal of Cardiac Failure, vol. 22, no. 3, pp. 201-209. https://doi.org/10.1016/j.cardfail.2015.09.016